Bureaucracy Has No Brain, Heart or Budget! Making Structure Work for Patient Safety, Motivation & Cost Effectiveness

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By June Fabre, RN, MBA

Author, Smart Nursing:  Nurse Retention & Patient Safety Improvement Strategies, Second Edition

Every organization has structure, but not all organizations have bureaucracy.

We need structure to work efficiently and serve patients. But, structure should be our tool, not our master.

Structure that becomes our master turns into bureaucracy.

Bureaucracy has no brain. Only your dedicated staff members can use their brains for the critical thinking needed to solve organizational problems.

What happens when structure turns into bureaucracy and becomes our master?

Money is lost because bureaucracy is expensive!

Motivated staff become disillusioned!

Mistakes become rampant!

Suppose that your critically thinking nurses notice safety problems but lack the autonomy to eliminate them due to a safety committee with a slow response.

This bureaucratic bottleneck wastes time, frustrates the nurses, and eventually injures patients.

This month’s best practice illustrates that it is quality that defines success, and that large provider groups aren’t necessarily better.

Research:  What do nurses need?
The Harvard researchers highlighted in my most recent Smart Nursing book made the following recommendations about enabling nurses to solve the root causes of potential errors.

First, if workers are to engage in root cause removal, this activity must be an explicit part of their job and enough time allocated for removal efforts.

Second, there needs to be frequent opportunities for communicating about problems with individuals who are responsible for supplying frontline workers with materials or information . . . There must be convenient opportunities in the course of the day for workers to give feedback.

Third, when the signal is given that there is a problem, proper attention must be paid to it. We must recognize communication as a valid step in the direction of improvement.

Often the best that the worker could do was to merely raise the issue, but too often this worker ran the risk of being considered a “complainer.” We did not observe any instances where the nurse contacted someone about a trivial or insignificant exception. In fact, we observed several occasions where we were surprised that the nurse did not raise awareness around a problem that we felt could have serious consequences. (Fabre, J, (2009) Smart Nursing-Nurse retention and patient safety improvement strategies, Second edition, New York: Springer, p. 109.

When the structures that support the work nurses do include elements of nurse engagement, communication opportunities, and responsive leadership, there will be an exciting increase in motivation, safety and cost effectiveness!

Smart Nursing
Nurse Retention & Patient Safety Improvement Strategies, Second Edition
June Fabre, MBA, RNC

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www.springerpub.com

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One Response to Bureaucracy Has No Brain, Heart or Budget! Making Structure Work for Patient Safety, Motivation & Cost Effectiveness

  1. Beth Boynton says:

    June,
    Thank you for your awesome article! I so agree. We are so bogged down with structures that interfere with our work and sometimes it is hard to find structure that supports it.

    When I have to spend 15 minutes on the phone with IT to get logged on to the computer system because my password, (one of four different passwords I have to have for all the different computer systems) has expired, or use two different keys to get a medication out of the med cart, but can use my fingerprint to clock in for work and clock out for breaks…..well I’m not feeling the support!

    One of the concepts I like to teach or coach leaders in is to think about the structure they need to build and maintain so that it does support the work. Keep our egos out of it as best we can, ensure patient safety and staff health, and drive ideas with cost effectiveness in mind, but not greed.

    Again, great article.

    Beth
    P.S. June was one of the nurses who participated in “Interruption Awareness” workshop and youtube.

What are your thoughts?